Wk 10, Case 3 - Review

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Patient History
Stroke suspected. slow to respond to questions and cannot spell WORLD backwards.

Findings
These images demonstrate abnormal high signal intensity in the anterior aspects of the temporal lobes bilaterally. This extends also to the external capsule and the periventricular and subcortical white matter in a diffuse manner. The findings are symmetric in degree and distribution. There is thinning of the top of the corpus callosum.

Post gadolinium enhanced scans show no evidence of enhancing lesions in the brain. The diffusion weighted scans show no evidence of restricted diffusion or an acute infarction.

A punctate area of hemosiderin deposition is present in the left parietal lobe, in the frontal opercular regions bilaterally, in the left temporal lobe.

Impressions
Diffuse white matter high signal intensity bilaterally affecting the anterior temporal lobes and the external capsule region in a pattern suggestive of CADASIL. Superimposed punctate areas of hemosiderin deposition also present, found in the entity.

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Joshua P Nickerson, MD

Associate Professor of Neuroradiology

Oregon Health & Science University

Francis Deng, MD

Assistant Professor of Radiology and Radiological Science

Johns Hopkins University School of Medicine

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Wk 10, Case 3 - Review